Impact of the successful flap but failed reconstruction on the true rate of success in free-tissue transfers.

Extraordinarily high success rates for free-tissue transfers are now virtually the norm. Unfortunately, expectations to consistently obtain similar outcomes, without a familiarity with the incidence of associated adverse sequelae, place microsurgeons in a potential quandary. A true success rate should consider not just those immediately viable flaps with patent microanastomoses, but should discount cases in which there is significant partial flap loss, or persistence or recurrence of the original indication for the free-flap transfer, including the need for delayed amputation of an extremity. An estimate of the impact of the latter phenomena in redefining success rates has been derived from the author\u27s experience with 156 free flaps over the past decade. There was overt failure in 12 flaps, for a stated success rate of 91.7 percent. However, on closer scrutiny, including the above negative criteria, successful flaps yet failures occurred in an additional 16 flaps, so that the true rate of success was a more realistic 81.4 percent. An even more difficult assessment that was not quantified is the reality of functional failures, despite successful microsurgery, which could lower this number even further